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e test that uses gallium to obtain images of tissues medical diagnostic method gallium 67 scan gallium scan showing uptake consistent with sarcoidosis synonyms gallium imaging icd 10 pcs c 1 lzz planar c 2 lzz tomographic icd 9 cm 92 18 ops 301 code 3 70c medlineplus 003450 a gallium scan is a type of nuclear medicine diagnostic investigation that uses either a gallium 67 67 ga or gallium 68 68 ga radiopharmaceutical to obtain images of a specific type of tissue or disease state of tissue the gamma emission of gallium 67 is imaged by a gamma camera while the positron emission of gallium 68 is imaged by positron emission tomography pet gallium salts like gallium citrate and gallium nitrate may be used the form of salt is not important since it is the freely dissolved gallium ion ga 3 which is active 1 as they are isotopic both 67 ga and 68 ga salts have the same uptake mechanisms 2 the gallium iii is rapidly bound by transferrin which then preferentially accumulates in tumors inflammation and both acute and chronic infection 3 4 allowing these pathological processes to be imaged gallium is particularly useful in imaging osteomyelitis that involves the spine and in imaging older and chronic infections that may be the cause of a fever of unknown origin 5 6 due to lack of disease specificity imaging with radioactive gallium iii salts or complexes such as 67 ga citrate has gradually become less important over time and is rarely used these days however the mentioned gallium iii radionuclides particularly 68 ga are frequently used as radiolabels for peptides proteins oligonucleotides drugs and drug like substance turning these from regular pharmaceuticals into radiotracers a popular class of such radiopharmaceuticals is formed by 68 ga labeled small molecule inhibitors for prostate specific membrane antigen psma which are increasingly used for prostate cancer imaging furthermore gallium 68 labeled octreotide analogs such as 68 ga dotatoc were among the first clinically successful 68 ga pet tracers and have meanwhile replaced indium 111 labeled octreotides for diagnostic imaging of somatostatin receptor positive neuroendocrine tumors investigations with 68 ga labeled peptides etc are however not commonly referred to as gallium scan usually they are named after the addressed target or labeled bioligand e g psma scan or dotatoc scan gallium citrate scan edit in the past the gallium scan was the gold standard for lymphoma staging until it was replaced by positron emission tomography pet using 18 f fluorodeoxyglucose fdg 7 8 67 ga citrate imaging is still used to image inflammation and chronic infections and it still sometimes locates unsuspected tumors as it is taken up by many kinds of cancer cells in amounts that exceed those of normal tissues thus an increased uptake of gallium 67 may indicate a new or old infection an inflammatory focus from any cause or a cancerous tumor it has been suggested that gallium imaging may become an obsolete technique with indium leukocyte imaging and technetium antigranulocyte antibodies replacing it as a detection mechanism for infections for detection of tumors especially lymphomas gallium 67 imaging is still in use but may be completely replaced by fluorodeoxyglucose 18f fluorodeoxyglucose pet imaging in the future 9 in infections the gallium scan has an advantage over indium leukocyte imaging in imaging osteomyelitis bone infection of the spine lung infections and inflammation and for chronic infections in part this is because gallium binds to neutrophil membranes even after neutrophil death indium leukocyte imaging is better for acute infections where neutrophils are still rapidly and actively localizing to the infection and also for osteomyelitis that does not involve the spine and for abdominal and pelvic infections both the gallium scan and indium leukocyte imaging may be used to image fever of unknown origin elevated temperature without an explanation however the indium leukocyte scan will image only the 25 of such cases which are caused by acute infections while gallium will also localize to other sources of fever such as chronic infections and tumors 10 11 mechanism edit the body generally handles ga 3 as though it were ferric iron fe 3 and thus the free ion is bound and concentrates in areas of inflammation such as an infection site and also areas of rapid cell division 12 gallium iii ga 3 binds to transferrin leukocyte lactoferrin bacterial siderophores inflammatory proteins and cell membranes in neutrophils both living and dead 13 lactoferrin is contained within leukocytes gallium may bind to lactoferrin and be transported to sites of inflammation or binds to lactoferrin released during bacterial phagocytosis at infection sites and remains due to binding with macrophage receptors 14 gallium 67 also attaches to the siderophore molecules of bacteria themselves and for this reason can be used in leukopenic patients with bacterial infection here it attaches directly to bacterial proteins and leukocytes are not needed 15 uptake is thought to be associated with a range of tumour properties including transferring receptors anaerobic tumor metabolism and tumor perfusion and vascular permeability 16 17 common indications edit whole body survey to localize source of fever in patients with fever of unknown origin 18 detection of pulmonary and mediastinal inflammation infection especially in the immunocompromised patient 19 evaluation and follow up of active lymphocytic or granulomatous inflammatory processes such as sarcoidosis or tuberculosis 20 diagnosing vertebral osteomyelitis and or disk space infection where gallium 67 is preferred over labeled leukocytes diagnosis and follow up of medical treatment of retroperitoneal fibrosis evaluation and follow up of drug induced pulmonary toxicity e g bleomycin amiodarone evaluation of patients who are not candidates for wbc scans wbc count less than 6 000 note that all of these conditions are also seen in pet scans using gallium 68 technique edit the main 67 ga technique uses scintigraphy to produce two dimensional images after the tracer has been injected images are typically taken by a gamma camera at 24 48 and in some cases 72 and 96 hours later 21 22 each set of images takes 30 60 minutes depending on the size of the area being imaged the resulting image will have bright areas that collected large amounts of tracer because inflammation is present or rapid cell division is occurring single photon emission computed tomography spect images may also be acquired in some imaging centers spect images may be combined with computed tomography ct scan using either fusion software or spect ct hybrid cameras to superimpose both physiological image information from the gallium scan and anatomical information from the ct scan a common injection dose is around 150 megabecquerels 23 imaging should not usually be sooner than 24 hours as high background at this time produces false negatives forty eight hour whole body images are appropriate delayed imaging can be obtained even 1 week or longer after injection if bowel is confounding spect can be performed as needed oral laxatives or enemas can be given before imaging to reduce bowel activity and reduce dose to large bowel however the usefulness of bowel preparation is controversial 22 10 to 25 of the dose of gallium 67 is excreted within 24 hours after injection the majority of which is excreted through the kidneys after 24 hours the principal excretory pathway is the colon 22 the target organ organ that receives the largest radiation dose in the average scan is the colon large bowel 21 in a normal scan uptake of gallium is seen in wide range of locations which do not indicate a positive finding these typically include soft tissues liver and bone other sites of localisation can be nasopharyngeal and lacrimal glands breasts particularly in lactation or pregnancy normally healing wounds kidneys bladder and colon 24 gallium psma scan edit see also psma scan ct scan left and gallium psma pet scan right of patient with prostate cancer metastases in the bones the positron emitting isotope 68 ga can be used to target prostate specific membrane antigen psma a protein which is present in prostate cancer cells the technique has been shown to improve detection of metastatic disease compared to mri or ct scans 25 in december 2020 the u s food and drug administration fda approved 68 ga psma 11 for medical use in the united states 26 27 it is indicated for positron emission tomography pet of prostate specific membrane antigen psma positive lesions in men with prostate cancer 28 27 it is manufactured by the ucla biomedical cyclotron facility 27 the fda approved 68 ga psma 11 based on evidence from two clinical trials trial 1 nct0336847 identical to nct02919111 and trial 2 nct02940262 identical to nct02918357 of male participants with prostate cancer 27 some participants were recently diagnosed with the prostate cancer 27 other participants were treated before but there was suspicion that the cancer was spreading because of rising prostate specific antigen or psa 27 the trials were conducted at two sites in the united states 27 the fda considers 68 ga psma 11 to be a first in class medication 29 common indications edit gallium psma scanning is recommended primarily in cases of biochemical recurrence of prostate cancer particularly for patients with low psa values and in patients with high risk disease where metastases are considered likely 30 31 technique edit an intravenous administration of 1 8 2 2 megabecquerels of 68 ga psma 11 per kilogram of bodyweight is recommended imaging should commence approximately 60 minutes after administration with an acquisition from mid thigh to the base of the skull 30 32 gallium dota scans edit 68 ga dota conjugated peptides including 68 ga dota tate dota toc and dota noc are used in positron emission tomography pet imaging of neuroendocrine tumours nets 33 the scan is similar to the spect octreotide scan in that an octreotide based somatostatin analogue such as edotreotide is used as the radioligand and there are similar indications and uses as octreotide scans however image quality is significantly improved 34 somatostatin receptors are overexpressed in many nets so that the 68 ga dota conjugated peptide is preferentially taken up in these locations and visualised on the scan 35 as well as diagnosis and staging of nets 68 ga dota conjugated peptide imaging may be used for planning and dosimetry in preparation for lutetium 177 or yttrium 90 dota therapy 36 37 in june 2016 netspot kit for the preparation of gallium ga 68 dotatate injection was approved for medical use in the united states 38 39 in august 2019 68 ga edotreotide injection 68 ga dotatoc was approved for medical use in the united states for use with pet imaging for the localization of somatostatin receptor positive neuroendocrine tumors nets in adults and children 40 41 42 the u s food and drug administration fda approved 68 ga edotreotide dotatoc based on evidence from three clinical trials trial 1 nct 1619865 trial 2 nct 1869725 trial 3 nct 2441062 of 334 known or suspected neuro endocrine tumors 41 the trials were conducted in the united states 41 gallium 68 ga oxodotreotide was approved for medical use in canada as netspot in july 2019 43 and as netvision in may 2022 44 the combination germanium 68 ge chloride gallium 68 ga chloride was approved for medical use in the european union in august 2024 45 other gallium 68 based pet scanning agents may also be based on the principle of attaching peptides to chelators such as the in development drug ga 68 trivehexin radiochemistry of gallium 67 edit gallium 67 is produced by a cyclotron using charged particle proton bombardment of enriched zn 68 the gallium 67 is then complexed with citric acid to form gallium citrate the half life of gallium 67 is 3 2617 days 46 it decays by electron capture also emitting gamma rays that are detected by a gamma camera the primary emissions are at 93 kev 39 of decays followed by 185 kev 21 and 300 kev 17 47 for imaging multiple gamma camera energy windows are used typically centred around 93 and 184 kev or 93 184 and 296 kev 22 radiochemistry of gallium 68 edit see also gallium 68 generator gallium 68 which has a half life much shorter than gallium 67 at 67 84 minutes is produced in a gallium 68 generator by decay of germanium 68 with a 271 05 day half life or as with gallium 67 by the irradiation of zinc 68 in a cyclotron use of a generator means a supply of 68 ga can be produced easily with minimal infrastructure for example at sites without a cyclotron commonly used to produce other pet isotopes it decays by positron emission and electron capture into zinc 68 46 the maximum energy of the desired positron emission is 1 899 mev 47 references edit treves st 2014 pediatric nuclear medicine and molecular imaging 4th ed springer p 480 isbn 978 1 4614 9551 2 jain sk 2017 imaging infections from bench to bedside springer p 34 isbn 978 3 319 54592 9 archived from the original on 21 february 2022 retrieved 23 june 2017 verberne sj and o p p temmerman 2017 12 imaging of prosthetic joint infections archived 21 february 2022 at the wayback machine arts j j chris management of periprosthetic joint infections pjis j geurts woodhead publishing 259 285 verberne sj raijmakers pg temmerman o 2016 the accuracy of imaging techniques in the assessment of periprosthetic hip infection a systematic review and meta analysis the journal of bone and joint surgery american volume 98 19 1638 1645 doi 10 2106 jbjs 15 00898 pmid 27707850 s2cid 9202184 retrieved 18 december 2016 termaat mf raijmakers pg scholten hj bakker fc patka p haarman hj november 2005 the accuracy of diagnostic imaging for the assessment of chronic osteomyelitis a systematic review and meta analysis the journal of bone and joint surgery american volume 87 11 2464 71 doi 10 2106 jbjs d 02691 inactive 12 july 2025 pmid 16264122 s2cid 26280068 cite journal cs1 maint doi inactive as of july 2025 link becker w october 1995 the contribution of nuclear medicine to the patient with infection european journal of nuclear medicine 22 10 1195 1211 doi 10 1007 bf00800606 pmid 8542906 s2cid 19293222 bryan rn 2010 introduction to the science of medical imaging cambridge cambridge university press p 200 isbn 978 0 521 74762 2 archived from the original on 21 february 2017 retrieved 20 february 2017 bleeker rovers cp vos fj van der graaf wt oyen wj 16 june 2011 nuclear medicine imaging of infection in cancer patients with emphasis on fdg pet the oncologist 16 7 980 991 doi 10 1634 theoncologist 2010 0421 pmc 3228133 pmid 21680576 ziessman ha o malley jp thrall jh 2013 nuclear medicine the requisites e book elsevier health sciences p 281 isbn 978 0 323 11292 5 palestro cj april 1994 the current role of gallium imaging in infection seminars in nuclear medicine 24 2 128 141 doi 10 1016 s0001 2998 05 80227 2 pmid 80231...
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